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November 12, 2025
Court Will Never Interpret Policy to Give Insured Coverage Not Purchased

Insured Refused to Pay Additional Premium for Assault & Battery Coverage
Post 5225

See the video at https://lnkd.in/g-h_eWr6 and at https://lnkd.in/gtcRKMiW, and at https://zalma.com/blog plus more than 5200 posts.

Exclusion for Assault & Battery Enforced

In Golden Bear Insurance Company v. The Levee Bar & Grill, LLC et al., No. 4:24-CV-00764-DGK (W.D. Mo. Nov. 7, 2025) the bar was sued because of an assault and battery by an intoxicated patron and sought defense and indemnity from its insurer. Golden Bear (GB) denied the claim because of an assault and battery exclusion in its policy.

FACTUAL BACKGROUND

Underlying Incident and Lawsuit:

On or about an unspecified date in 2024, Defendant Adrian Hubbard (“Hubbard”), a patron at The Levee, became intoxicated after being overserved alcohol. He was removed from the bar without incident but later engaged in a brief altercation outside, bumping a female security guard. An unknown employee of The Levee (“John Doe”), perceiving a threat to himself or the guard, struck Hubbard in the head, causing him to fall and strike his head on the pavement, resulting in injuries.

Underlying Claims:

Hubbard filed suit against The Levee and John Doe in Jackson County, Missouri Circuit Court on May 20, 2024 (initial petition), alleging negligent overservice of alcohol and removal. An amended petition filed October 3, 2024, added claims of: (1) negligent supervision/training of John Doe (who allegedly had a proclivity for excessive force, which The Levee condoned); and (2) negligence in John Doe’s use of unreasonable force while acting within the scope of employment.

Coverage Denial:

The Levee tendered the claim to GB Insurance on June 26, 2024, and again after the amendment. GB Insurance denied coverage both times, citing the Exclusion.

Insurance Policy:

Plaintiff Golden Bear Insurance Company (“GB Insurance”) issued a Commercial General Liability policy to Defendant The Levee Bar & Grill, LLC (“The Levee”) for the period January 18, 2023, to January 18, 2024. The policy includes an “Assault and Battery Exclusion” (the “Exclusion”) that bars coverage for bodily injury arising from enumerated acts, allegations, or causes of action, including assault and battery. It contains a “Separation of Insureds” provision, treating coverage for each insured separately as if they were the sole insured.

PROCEDURAL HISTORY

GB filed this federal declaratory judgment action under 28 U.S.C. § 2201, seeking a declaration of no duty to defend or indemnify The Levee in the underlying lawsuit due to the Exclusion. The court stayed the underlying action pending resolution.

GB Insurance moved for judgment on the pleadings.

Issues

1 Does the Exclusion preclude coverage for the underlying claims?
2 Is the Exclusion void as against Missouri public policy, which favors self-defense?

ANALYSIS

To succeed on a motion to dismiss the movant must show no material factual issues remain and entitlement to judgment as a matter of law.

Applicability of Exclusion:

Defendants did not contest GB Insurance’s argument that the Exclusion bars coverage for the underlying tort claims (negligent supervision/training and negligence arising from the alleged assault). This constitutes waiver.
Exclusion Not Void Against Public Policy:

Defendants argued the Exclusion violates Missouri’s policy favoring self-defense (citing a carve-out for “reasonable force to protect persons or property”), entitling coverage for John Doe’s alleged defensive act. The court rejected this as “borderline frivolous,” unsupported by caselaw.

Distinction Between Defenses and Coverage:

Self-defense is a valid criminal/civil defense insulating from liability, but it does not mandate insurance coverage for intentional/excluded conduct. These are separate issues.

Contract Interpretation:

Missouri courts will not rewrite policies to create unagreed coverage. The Levee could have purchased optional assault/battery coverage (at extra premium) but did not. Enforcing the Exclusion upholds freedom of contract and is not against public policy.

HOLDING

The motion was granted. GB Insurance had no duty to defend or indemnify The Levee (or any insured) in the underlying lawsuit because the Exclusion applies without material factual dispute. The Exclusion is enforceable.

CONCLUSION

The court declared the Exclusion applies, absolving GB Insurance of defense/indemnity duties.

ZALMA OPINION

Insurance policies limit the risks that the insurer is willing to take. When insuring a bar insurers are usually concerned with the liability of the bar for injuries to third parties due to the intoxication of patrons and the actions of staff to quell disputes between intoxicated persons. GB offered the insured coverage for assault and battery at a higher premium which the insured rejected and opted for the policy with the exclusion and took their chances. When sued the bar attempted to change the policy wording to obtain coverage for which they did not pay a premium only to find itself responsible individually for the costs of defense and indemnity.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:08:29
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September 18, 2026
Expert May Only Testify to What Experience Supports

Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.

Posted on September 18, 2026 by Barry Zalma

See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html

In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.

The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.

Law

The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

150 Months in Prison for Tax Fraud
Post 4846

Posted on September 17, 2026 by Barry Zalma

See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.

FACTS

In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS

Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.

The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution

Post 5489

Posted on September 14, 2026 by Barry Zalma

Fraudster Refuses to Answer Questions About His Alleged Fraud

See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr

In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.

Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.

After Great American ...

00:05:14
October 02, 2026
Announcement About False Claims Act Settlement Results in Damages Suit

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No Statutory Hearing Right Arose Because No Dental Commission Complaint License Suspension, Revocation, Or Sanction Occurred.

Post 4855

Posted on October 2, 2026 by Barry Zalma

In Abbas Mohammadi et al. v. William M. Tong et al., No. AC 47598, Court of Appeals of Connecticut (September 29, 2026) Abbas Mohammadi owned and operated Columbia Dental, P.C., which provided dental services through multiple Connecticut offices; Columbia Oral Maxillofacial Imaging, LLC served as the billing entity.

From April 2012 to February 27, 2013, Columbia Dental employed Brittany Ames Mahoney as a dental assistant. During her employment, Mahoney claimed to have discovered certain billing irregularities, including, but not limited to, false and fraudulent reimbursement claims submitted to the Department of Social Services for services rendered to Medicaid beneficiaries. Mahoney filed a complaint and an affidavit in the United States District Court for the District of...

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October 01, 2026
Zalma’s Insurance Fraud Letter – October 1, 2026

Another Anniversary for Barry Zalma, Inc

Posted on October 1, 2026 by Barry Zalma
From October 1, 1979 – 2026

Post 4854

Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/09/ZIFL-10-01-2026.pdf Forty seven years ago today I left the world of the employed and became an entrepreneur by opening my own law firm. The law practice was incorporated shortly thereafter as Barry Zalma, Inc.

When I opened for business on October 1, 1979, I had no clients and no certainty that I would have any in the future. I had borrowed money from the bank to carry me through the first six months and was concerned about my ability to pay the loan with my third child about to be born.

Much to my surprise and pleasure, on October 1, 1979, at 8:10 a.m., the best claims handler in the London market, Alan Warboys, called from London and provided me with my first case as an independent lawyer to represent Certain Underwriters at Lloyd’s, London. He, and the Lloyd’s Underwriters he represented, showed faith in me as a lawyer and insurance expert. Alan is now, although ...

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September 30, 2026
Suing for Services Provided, and Paid for, is Fraud

Defendants Successfully Moved for Summary Judgment

Post 4854

Posted on September 30, 2026 by Barry Zalma

In Jeffrey Wayne Phillips v. Creative Website Studios, et al., No. 5:23-CV-568-BO-BM, United States District Court, E.D. North Carolina, Western Division (September 28, 2026) the Court needed to rule on the order and memorandum and recommendation (“M&R”) of the Magistrate.

Jeffrey Wayne Phillips had contracted with Creative Website Studios and SR Telecommunications for website and hosting services. He alleged that defendants repeatedly billed him for hosting periods he had already paid for and later took down his website. Phillips claimed the outage prevented him from bidding on U.S. government security contracts and sought roughly $300 million in consequential damages.
LAW

Under North Carolina law, fraud requires a false material representation or concealment, intent and effect of deception, resulting damage, and reasonable reliance. Obtaining property by false pretenses similarly requires an ...

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